Revision connectors, systems and methods thereof

ABSTRACT

Connector assemblies, systems, and methods thereof. A connector has a first end that clamps to a first rod in an existing construct and a second end, connected to the first end, that clamps to a second rod in a new construct such that the new construct can be extended from the existing construct at an adjacent level as the existing construct.

CROSS-REFERENCE TO RELATED APPLICATION

The present application is a Continuation of U.S. patent applicationSer. No. 16/751,482, filed Jan. 24, 2020, which is a Continuation ofU.S. patent application Ser. No. 15/346,199, filed Nov. 8, 2016, whichis a Continuation-in-Part of U.S. patent application Ser. No.15/228,019, filed Aug. 4, 2016, which is a Continuation-in-Part of U.S.patent application Ser. No. 15/083,467, filed Mar. 29, 2016, all ofwhich are incorporated herein by reference in their entireties for allpurposes.

BACKGROUND Field of the Invention

The present invention relates to rod connectors, such as spinal hardwareconnectors.

Description of the Related Art

At times, spinal surgeons may be required to add additional fixation tospinal segments adjacent to previously instrumented levels. In thesecases, the hardware from the initial surgery may interfere withplacement of new fixation for the adjacent level. Therefore, there is aneed for connector implants that attach to the existing spinal fusionconstruct on one end and extend fixation to adjacent levels in need offusion. Quicker recovery times and lessened discomfort makes minimallyinvasive surgical (MIS) techniques favorable in these situations.

SUMMARY

This Summary is provided to introduce a selection of concepts in asimplified form that are further described below in the DetailedDescription. This Summary is not intended to identify key features oressential features of the claimed subject matter, nor is it intended tobe used to limit the scope of the claimed subject matter.

The present disclosure relates to components, systems, and methods forconnecting one device to another device. For example, one elongateimplant, such as a first rod, may be coupled to another elongateimplant, such as a second rod. The elongate implants, such as rods, arewell known to connect adjacent vertebrae in a spinal fusion procedure.Depending on the configuration of rods or implants, it may be desirableto have one rod connected to another rod or additional implant. In thecase of two or more rods, these rods may be interconnected with one ormore connectors, for example, in a single given surgery, such as ascoliosis operation, or at a later surgery, for example, in a revisionsurgery. In a revision surgery, connectors can be used to connect newfixation constructs to existing fixation constructs without the need toremove the original hardware. The different connection modes provided inthe following exemplary embodiments offer a range of options to bechosen based on a specific clinical scenario and/or surgeon preference.Although certain configurations are shown herein, it is envisioned thatany suitable number, type, and selection of connectors and implants maybe chosen and configured by the skilled surgeon.

According to one embodiment, an articulating revision connector assemblymay include a connector that is configured to connect a new construct toan existing construct in a patient.

In one embodiment, the articulating revision connector assemblycomprises a rod and a connector attached to the rod. The connectorincludes an open clamp portion having a securing mechanism rotatablyconnected thereto and a closed clamp portion rotatably connected to theopen clamp portion. The closed clamp portion has a passage extendingtherethrough. The passage is sized to allow passage of the rodtherethrough. A locking mechanism is configured to releasably preventrotation of the closed clamp portion relative to the open clamp portionwhen the rod is inserted into the passage.

In an alternative embodiment, the articulating revision connectorassembly comprises a rod and a connector releasably connected to therod. The connector includes a first connecting portion extending along alongitudinal axis. The first connecting portion has a first end havingan open connection adapted to releasably retain the rod and a second endhaving a blind passage extending along the longitudinal axis. A secondconnecting portion is rotatably connected to the second end of the firstconnecting portion. The second connecting portion has an axial passageextending generally orthogonal to the longitudinal axis.

In still another alternative embodiment, a method of adding a newconstruct to an existing construct comprises the steps of: providing aconnector having a first connecting portion with an open connection anda second connecting portion rotatably connected to the first connectingportion, the second connecting portion having an axial passage extendingtherethrough; inserting the open connection over a first rod in theexisting construct; securing the first connecting portion to the firstrod; inserting a second rod through the axial passage; rotating thesecond connecting portion relative to the first connecting portion to adesired location; and securing the second rod to the second connectingportion, thereby restricting rotation of the second connecting portionwith respect to the first connecting portion.

In yet another exemplary embodiment, a spinal revision connectorassembly comprises a body having a first end and a second end, a firstconnecting member at the first end, and a rod extending from the secondend.

Another exemplary embodiment of a spinal revision connector assemblycomprises an elongate rod having a first end and a second end, a taperedtip at the first end, and a securing structure at the second end.

In still another exemplary embodiment, the spinal revision connectorassembly comprises a rod and a connector portion attached to an end ofthe rod. The connector portion has a space sized to allow the passage ofa construct therethrough and a connector distal from the rod.

According to another exemplary embodiment, a connector comprises a firstclamping portion having a first passage having a first longitudinal axisextending therethrough and being sized to allow a first rod to beinserted thereinto along the first longitudinal axis, a bottom portionhaving an opening in communication with the first passage, and a firstsecuring mechanism rotatably connected thereto. The first securingmechanism is adapted to releasably secure the first rod in the firstpassage. A second clamping portion has a second passage having a secondlongitudinal axis extending therethrough such that the secondlongitudinal axis is parallel to the first longitudinal axis. The secondpassage is sized to allow a second rod to be inserted thereinto alongthe second longitudinal axis.

In another exemplary embodiment, a connector comprises a body having abottom surface extending between a first end and a second end. The firstend has a generally U-shaped first opening extending from the bottomsurface such that the U-shaped opening is sized to receive a first rodextending therethrough along a first axis. A securing mechanism isextendable into the first opening to releasably secure the first rod tothe body. The second end has a second opening extending therethroughalong a second axis, parallel to the first axis. The second opening issized to receive a second rod.

In still another exemplary embodiment, a method of adding a newconstruct to an existing construct comprises the steps of providing aconnector having a first connecting portion with an open connection anda second connecting portion having an axial passage extendingtherethrough; inserting the open connection over a first rod in theexisting construct; securing the first connecting portion to the firstrod; inserting a second rod through the axial passage; and securing thesecond rod to the second connecting portion.

According to another embodiment, a connector includes a body having afirst clamping portion and a second clamping portion. The first clampingportion has a first passage having a first longitudinal axis extendingtherethrough and being sized to allow a first rod to be insertedtherein; a bottom portion having an opening in communication with thefirst passage; and a first securing mechanism comprising a set screw, aclamp having two opposing legs, and an opening defined between the twoopposing legs, the clamp being connected to the set screw and the setscrew being rotatably connected to the body, the first securingmechanism having an unlocked position configured to receive the firstrod and a locked position configured to releasably secure the first rodin the opening between the two opposing legs of the clamp and in thefirst passage. The second clamping portion has a second passage having asecond longitudinal axis extending therethrough, the second longitudinalaxis being substantially parallel to the first longitudinal axis, andthe second passage being sized to allow a second rod to be insertedtherein along the second longitudinal axis.

According to yet another embodiment, a connector includes a body havinga first clamping portion and a second clamping portion. The firstclamping portion has a first passage sized and dimensioned to receive afirst rod, and a transverse opening extending through and being incommunication with the first passage; and a first securing mechanismcomprising a set screw and a clamp having two opposing legs, and anopening defined between the two opposing legs, the clamp being connectedto the set screw and the set screw being rotatably connected to thebody, the set screw being received in an upper portion of the transverseopening and configured to allow the clamp to slidably translate throughthe transverse opening. The second clamping portion has a second passagesized and dimensioned to receive a second rod.

BRIEF DESCRIPTION OF THE DRAWINGS

Other aspects, features, and advantages of the present invention willbecome more fully apparent from the following detailed description, theappended claims, and the accompanying drawings in which like referencenumerals identify similar or identical elements.

FIG. 1 is a side elevational view of an articulating revision connectoraccording to a first exemplary embodiment;

FIG. 2 is a perspective view of the articulating revision connectorshown in FIG. 1 connected to an existing rod construct;

FIG. 3 is a perspective view of the articulating revision connector androd construct shown in FIG. 2, with the connector also being connectedto a newly installed rod;

FIG. 4A-E are end elevational views of the connector shown in FIG. 1,with the articulating portion rotated about multiple angles with respectto the fixed portion of the connector;

FIG. 5 is a sectional view of the articulating revision connector shownin FIG. 1;

FIG. 6 is a side elevational view of an articulating revision connectoraccording to a second exemplary embodiment;

FIG. 7 is a perspective view of an articulating revision connectoraccording to a third exemplary embodiment;

FIG. 8 is a perspective view of the connector shown in FIG. 7 connectedto an existing rod construct and a newly installed rod;

FIG. 9 is a perspective view of an articulating revision connectoraccording to a fourth exemplary embodiment;

FIG. 10 is a perspective view of the connector shown in FIG. 9,connected to an existing rod construct and a newly installed rod;

FIG. 11 is a perspective view of an articulating revision connectoraccording to a fifth exemplary embodiment;

FIG. 12 is a perspective view of an integrated revision connectoraccording to a sixth exemplary embodiment;

FIG. 13 is a perspective view of an integrated revision connectoraccording to a seventh exemplary embodiment;

FIG. 14 is a perspective view of the integrated revision connector shownin FIG. 13, connected to an existing construct;

FIG. 15 is a side elevational view of the integrated revision connectorconnected to an existing construct shown in FIG. 14

FIG. 16 is a perspective view of the integrated revision connector shownin FIG. 13, alternatively connected to an existing construct;

FIG. 17 is a perspective view of an integrated revision connectoraccording to an eighth exemplary embodiment;

FIG. 18 is a perspective view of the integrated revision connector shownin FIG. 17, connected to an existing construct;

FIG. 19 is a perspective view of an integrated revision connectoraccording to a ninth exemplary embodiment, connected to an existingconstruct;

FIG. 20 is a perspective view of an integrated revision connectoraccording to a tenth exemplary embodiment;

FIG. 21 is a perspective view of the integrated revision connector shownin FIG. 20, connected to an existing construct;

FIG. 22 is a perspective view of the integrated revision connector shownin FIG. 20, alternatively connected to an existing construct;

FIG. 23 is a perspective view of an integrated revision connectoraccording to an eleventh exemplary embodiment;

FIGS. 24A-D are side elevational views of advancing stages of aconnecting mechanism of the integrated revision connector shown in FIG.23;

FIG. 25 is a sectional view of the connecting mechanism of theintegrated revision connector shown in FIG. 23;

FIG. 26 is a sectional view of the connecting mechanism of theintegrated revision connector shown in FIG. 23, connected to an existingconstruct;

FIG. 27 is a perspective view of the integrated revision connector shownin FIG. 23, connected to the existing construct;

FIG. 28 is a perspective view of a link connector according to a twelfthexemplary embodiment;

FIG. 29 is a side elevational view of the link connector shown in FIG.28, connected to adjacent screws;

FIG. 30 is a perspective view of a lateral connector according to athirteenth exemplary embodiment;

FIG. 31 is a perspective view of a top loading connector according to afourteenth exemplary embodiment;

FIG. 32 is a perspective view of the link connector shown in FIG. 28 andthe lateral connector shown in FIG. 30, connected to an existingconstruct and supporting a new construct;

FIG. 33 is a perspective view of a lateral offset link connectoraccording to a fifteenth exemplary embodiment;

FIG. 34 is a perspective view of the lateral offset length connectorshown in FIG. 33 and the lateral connector shown in FIG. 30, connectedto an existing construct and supporting a new construct;

FIG. 35 is a perspective view of a sagittal offset link connectoraccording to a sixteenth exemplary embodiment;

FIG. 36 is a side elevational view of the sagittal offset connectorshown in FIG. 35, and the lateral connector shown in FIG. 30, connectedto an existing construct and supporting a new construct;

FIG. 37 is a perspective view of a revision connector according to aseventeenth exemplary embodiment;

FIG. 38 is a side elevational view of the revision connector shown inFIG. 37;

FIG. 39 is a front elevational view of the revision connector shown inFIG. 37;

FIG. 40 is a side elevational view of the revision connector shown inFIG. 37, mounted on an existing construct;

FIG. 41 is a sectional view of the revision connector and existingconstruct shown in FIG. 40;

FIG. 42 is a sectional view of a revision connector according to aneighteenth exemplary embodiment, mounted on an existing construct;

FIG. 43 is a side elevational view of the revision connector shown inFIG. 42, connecting a new construct to the existing construct;

FIG. 44 is a perspective view of a revision connector according to anineteenth exemplary embodiment;

FIG. 45 is a sectional view of the revision connector shown in FIG. 44,mounted on an existing construct;

FIG. 46 is a side elevational view of the revision connector shown inFIG. 45, connecting a new construct to the existing construct;

FIG. 47 is a perspective view of a revision connector according to atwentieth exemplary embodiment;

FIG. 48 is a sectional view of the revision connector shown in FIG. 47,with a set screw, mounted on existing construct;

FIG. 49 is a sectional view of the revision connector shown in FIG. 47,with a wedge, mounted on existing construct;

FIG. 50 is a side elevational view of the revision connector shown inFIG. 47, connecting a new construct to the existing construct;

FIG. 51 is a sectional view of the lateral connector shown in FIG. 30,mounted on an existing construct;

FIG. 52 is a perspective view of a new construct mounted on the lateralconnector shown in FIG. 30;

FIG. 53 is a perspective view of the lateral connector shown in FIG. 30,connecting the new construct to the existing construct;

FIG. 54 is a top plan view of the lateral connector shown in FIG. 30,connecting the new construct to the existing construct;

FIG. 55 is a perspective view of the top loading connector shown in FIG.31, mounted on an existing construct;

FIG. 56 is a perspective view of the top loading connector shown in FIG.31, connecting a new construct to the existing construct;

FIG. 57 is a side elevational view of the top loading connector shown inFIG. 31, connecting the new construct to the existing construct;

FIG. 58 is a perspective view of an offset revision rod according to atwenty-first exemplary embodiment;

FIG. 59 is a top plan view of the offset revision rod shown in FIG. 58;

FIG. 60 is a side elevational view of a distraction/compression clampaccording to a twenty-second exemplary embodiment;

FIG. 61 is a perspective view of the distraction/compression clamp shownin FIG. 60, connected to existing construct;

FIG. 62 is a side perspective view of a double head lateral connectoraccording to a twenty-third exemplary embodiment;

FIG. 63 is a side elevational view of the double head lateral connectorshown in FIG. 62;

FIG. 64 is a top perspective view of the double head lateral connectorshown in FIG. 62;

FIG. 65 is a perspective view of a double head in-line connectoraccording to a twenty-fourth exemplary embodiment;

FIG. 66 is a perspective view of a J-hook connector according to atwenty-fifth exemplary embodiment;

FIG. 67 is a perspective view of a modular head open lateral connectorwith connected rods according to a twenty-sixth exemplary embodiment;

FIG. 68 is a side elevational view modular open head lateral connectorwith connected rods shown in FIG. 67;

FIG. 69 is a perspective view of a single head open lateral connectoraccording to a twenty-seventh exemplary embodiment;

FIG. 70 is a perspective view of a double modular lateral connectoraccording to a twenty-eighth exemplary embodiment;

FIG. 71 is a side elevational view of a Z-rod according to atwenty-ninth exemplary embodiment;

FIG. 72 is a perspective view of an in-line connector with integratedrod according to a thirtieth exemplary embodiment;

FIG. 73 is a perspective view of a top loading lateral connector with aclosed connector portion according to a thirty-first exemplaryembodiment;

FIG. 74 is a sectional view of the connector shown in FIG. 73;

FIG. 75 is a perspective view of a top loading lateral connector with anopen side connector portion according to a thirty-second exemplaryembodiment;

FIG. 76 is a perspective view of a top loading lateral connector with atulip portion according to a thirty-third exemplary embodiment;

FIG. 77 is a perspective view of a top loading lateral connector with asliding member according to a thirty-fourth embodiment;

FIG. 78 is a cross-sectional view of the connector shown in FIG. 77;

FIG. 79 is a perspective view of a top loading connector lateral with apivoting member according to a thirty-fifth embodiment;

FIG. 80 is a cross-sectional view of the connector shown in FIG. 79;

FIG. 81 is a perspective view of a top loading lateral connector with acam lock according to a thirty-sixth embodiment;

FIG. 82 is a sectional view of the connector shown in FIG. 81, with thecam in an unlocking position;

FIG. 83 is a sectional view of the connector shown in FIG. 81, with thecam in an locking position;

FIG. 84 is a top plan view of the connector shown in FIG. 81 connectedto a rod, with the cam in the unlocking position;

FIG. 85 is a top plan view of the connector shown in FIG. 81 connectedto a rod, with the cam in the locking position;

FIG. 86 is an exploded side elevational view of a top loading connectoraccording to a thirty-seventh embodiment;

FIG. 87 is a side elevational view of the top loading connector shown inFIG. 86;

FIG. 88 is a sectional view of the top loading connector shown in FIG.86;

FIG. 89 is a sectional view of the top loading connector shown in FIG.86, with the connector clamped onto a rod;

FIG. 90 is a side elevational view of the connector shown in FIG. 86clamped onto a rod assembly with a screw tulip connector mounted on topof the connector;

FIG. 91 is a side elevational view of the connector shown in FIG. 86clamped onto a rod assembly with a connector mounted on top of theconnector;

FIG. 92 is an exploded side elevational view of a top loading connectoraccording to a thirty-eighth embodiment;

FIG. 93 is a side elevational view of the top loading connector shown inFIG. 92;

FIG. 94 is a sectional view of the top loading connector shown in FIG.92;

FIG. 95 is a sectional view of the top loading connector shown in FIG.92, with the connector clamped onto a rod;

FIG. 96 is a side elevational view of the connector shown in FIG. 92clamped onto a rod assembly with a screw tulip connector mounted on topof the connector;

FIG. 97 is a side elevational view of the connector shown in FIG. 92clamped onto a rod assembly with a connector mounted on top of theconnector;

FIGS. 98A-98G depict a closed top loading connector according to yetanother embodiment;

FIG. 99 provides a top loading lateral connector according to yetanother embodiment; and

FIG. 100 is a top loading connector with a tulip connection according toyet another embodiment.

DETAILED DESCRIPTION

In the drawings, like numerals indicate like elements throughout.Certain terminology is used herein for convenience only and is not to betaken as a limitation on the present invention. The terminology includesthe words specifically mentioned, derivatives thereof and words ofsimilar import. The embodiments illustrated below are not intended to beexhaustive or to limit the invention to the precise form disclosed.These embodiments are chosen and described to best explain the principleof the invention and its application and practical use and to enableothers skilled in the art to best utilize the invention.

Reference herein to “one embodiment” or “an embodiment” means that aparticular feature, structure, or characteristic described in connectionwith the embodiment can be included in at least one embodiment of theinvention. The appearances of the phrase “in one embodiment” in variousplaces in the specification are not necessarily all referring to thesame embodiment, nor are separate or alternative embodiments necessarilymutually exclusive of other embodiments. The same applies to the term“implementation.”

As used in this application, the word “exemplary” is used herein to meanserving as an example, instance, or illustration. Any aspect or designdescribed herein as “exemplary” is not necessarily to be construed aspreferred or advantageous over other aspects or designs. Rather, use ofthe word exemplary is intended to present concepts in a concretefashion.

Additionally, the term “or” is intended to mean an inclusive “or” ratherthan an exclusive “or”. That is, unless specified otherwise, or clearfrom context, “X employs A or B” is intended to mean any of the naturalinclusive permutations. That is, if X employs A; X employs B; or Xemploys both A and B, then “X employs A or B” is satisfied under any ofthe foregoing instances. In addition, the articles “a” and “an” as usedin this application and the appended claims should generally beconstrued to mean “one or more” unless specified otherwise or clear fromcontext to be directed to a singular form.

Unless explicitly stated otherwise, each numerical value and rangeshould be interpreted as being approximate as if the word “about” or“approximately” preceded the value of the value or range.

The use of figure numbers and/or figure reference labels in the claimsis intended to identify one or more possible embodiments of the claimedsubject matter in order to facilitate the interpretation of the claims.Such use is not to be construed as necessarily limiting the scope ofthose claims to the embodiments shown in the corresponding figures.

It should be understood that the steps of the exemplary methods setforth herein are not necessarily required to be performed in the orderdescribed, and the order of the steps of such methods should beunderstood to be merely exemplary. Likewise, additional steps may beincluded in such methods, and certain steps may be omitted or combined,in methods consistent with various embodiments of the present invention.

Although the elements in the following method claims, if any, arerecited in a particular sequence with corresponding labeling, unless theclaim recitations otherwise imply a particular sequence for implementingsome or all of those elements, those elements are not necessarilyintended to be limited to being implemented in that particular sequence.

Also for purposes of this description, the terms “couple,” “coupling,”“coupled,” “connect,” “connecting,” or “connected” refer to any mannerknown in the art or later developed of joining or connecting two or moreelements directly or indirectly to one another, and the interposition ofone or more additional elements is contemplated, although not required.Conversely, the terms “directly coupled,” “directly connected,” etc.,imply the absence of such additional elements.

The present disclosure relates to components, systems, and methods forconnecting one elongate implant, such as a first rod, to anotherelongate implant, such as a second rod. The elongate implants, such asrods, are well known to connect adjacent vertebrae in a spinal fusionprocedure. Depending on the configuration of rods or implants, it may bedesirable to have one rod connected to another rod or additionalimplant. In the case of two or more rods, these rods may beinterconnected with one or more connectors, for example, in a singlegiven surgery, such as a scoliosis operation, or at a later surgery, forexample, in a revision surgery.

For example, connectors can be used to connect new fixation constructsto existing fixation constructs without the need to remove index surgeryhardware. A benefit to such direct attachment to existing constructssaves operating time, causes less disruption to the patient, andminimizes patient healing time. The ability of the inventive connectorsto maintain connection with existing constructs can maximize utility incases of varying patient anatomy and existing spinal constructs. Thedifferent connection modes provided in the following exemplaryembodiments offer a range of options to be chosen based on a specificclinical scenario and/or surgeon preference. Thus, although certainconfigurations are shown herein, it is envisioned that any suitablenumber, type, and selection of connectors and implants, such as rods,may be chosen and configured by the skilled surgeon.

While the different connection modes disclosed herein can be usedindependently, those skilled in the art will recognize that theconnection modes can be combined “à la carte” according to patientneeds. Further, while the connection modes disclosed herein can beprovided separately, kits that include various and multiple combinationsof different connection modes can also be provided.

Referring to FIGS. 1-5, an articulating revision connector assembly 100(“connector assembly 100”) according to a first exemplary embodiment isshown. Connector assembly 100 is used to attach to a first rod 50, forexample, that is already present in an existing construct. As shown inFIG. 2, first rod 50 can be supported by and secured to one or morescrew heads 60 (e.g., a tulip assembly connected to a polyaxial pediclescrew). Although not shown, a cap or securing member, such as a threadedcap, may then be engaged with the threaded portion of the tulip tosecure the rod 50 therein. While FIG. 2 shows connector assembly 100 asbeing located between screw heads 60, those skilled in the art willrecognize that connector assembly 100 can be located in other placesalong first rod 50. For example, the connector assembly 100 canpositioned such that it is substantially in contact with a portion ofthe screw heads 60 (e.g. substantially in contact with an outer portionof the tulip assembly).

Referring back FIG. 1, connector assembly 100 is an open lateralconnector that extends an existing construct an adjacent level.Connector assembly 100 includes an open clamp portion 110 rotatablyconnected to a closed clamp portion 130 that provides articulation aboutopen clamp portion 110 to a desired angle. Once the desired rotationalposition is achieved, closed clamp portion 130 can be secured to openclamp portion 110, locking the articulation.

Open clamp portion 110 includes a securing mechanism 112, such as a setscrew, that is rotatably connected thereto. Open clamp portion 110includes a blind passage 114 with a clamp opening 116 that extends alonga first axis “A1”. Securing mechanism 112 is mounted in a throughpassage 118 (shown in FIG. 5) extending generally orthogonally relativeto first axis A1.

Closed clamp portion 130 is rotatably connected to open clamp portion110. Closed clamp portion 130 has a passage 132 extending therethroughthat is sized to allow passage of a second rod 70 (shown in FIG. 3)therethrough. The passage 132 is preferably sized and shaped to receivethe rod 70. In the embodiment shown, the passage 132 is elongated tohave a length greater than its width to allow for some translation ofthe rod 70 in the passage 132 before the securing member 134 istightened. It is envisioned, however, that the passage 132 may besubstantially circular or cylindrical in shape. Rod 70 may be a Z-rod(shown in FIG. 71) in order to extend rod 50 co-linearly, as shown inFIG. 3. Although not shown, any other suitable rod may be selected, forexample, to allow for a parallel configuration or to select a rod thatmay be bent in situ.

Closed clamp portion 130 includes a securing member 134 that is adaptedto bias second rod 70. Securing member 134 is rotatably mounted in athrough-passage 135 that extends generally obliquely relative tolongitudinal axis A1. The rotation of closed clamp portion 130 relativeto open clamp portion 110 is illustrated in FIGS. 4A-4E, which showclosed clamp portion 130 rotated across five different positionsrelative to open clamp portion 110. Those skilled in the art willrecognize that closed clamp 130 has 360° of rotation relative to openclamp portion 110. It is envisioned, however, that the clamp 130 may bepermitted to rotate any suitable amount relative to open clamp portion110.

Referring to FIG. 5, a locking mechanism 150 is configured to releasablyprevent rotation of closed clamp portion 130 relative to open clampportion 110 when rod 70 (not shown in FIG. 5) is inserted into passage132. Locking mechanism 150 includes a blind passage 152 formed in closedclamp portion 130 and extending along longitudinal axis A1. Passage 152has a first set of teeth 154. An insert 156 is longitudinally disposedin passage 152. Insert 156 has a second set of teeth 158 that arereleasably engageable with the first set of teeth 154, such that, wheninsert 156 is longitudinally translated toward open clamp portion 110,second set of teeth 158 engages first set of teeth 154, restrictingrotation of open clamp portion 110 relative to closed clamp portion 130.

Passage 152 has an outwardly flared opening 160, and insert 156 has acorresponding outwardly flared end 162 that is adapted to engageoutwardly flared opening 160 when insert 156 is longitudinallytranslated toward open clamp portion 110. Flared opening 160 of passage152 also includes a lip 164 that extends radially away from first axisA1.

A cap 170 is threadably connected to closed clamp portion 130 torotatably retain closed clamp portion 130 on open clamp portion 110. Cap170 includes a threaded connection 172 that threadably engaged withmating threads 174 on closed clamp portion 130. An exterior of cap 170also includes radially spaced recesses 176 allow for the application ofa tool (not shown), such as, for example, a spanner wrench, toattach/remove cap 170 to/from closed clamp portion 130.

A plurality of bushings and washers 180-184 are located on the exteriorof open clamp portion 110 between cap 170 and lip 164 and serve to forma frictional connection between cap 170 and lip 164 when closed clampportion 130 is locked to open clamp portion 110.

To assemble connector assembly 100 and add rod 70 to an existingconstruct, clamp opening 116 of connector assembly 100 is secured to rod50, and rod 70 is then inserted into passage 132 as shown in theexemplary configuration shown in FIG. 3. When rod 70 is located at adesired angle with respect to rod 50, securing mechanism 112 is advancedthrough passage 118, such that securing mechanism 112 biases rod 70against insert 156, advancing insert 156 along longitudinal axis A1toward passage 114. Teeth 158 on insert 156 engage with teeth 154 inpassage 152 and seat flared end 162 of insert 156 on flared opening 160of passage 152, forcing lip 164 to bias toward cap 170, therebyrestricting rotation of open clamp portion 110 relative to closed clampportion 130.

In an alternative embodiment, shown in FIG. 6, a clamp assembly 200incorporates closed clamp portion 130, but, instead of open clampportion 110, includes an open clamp portion 210 rotatably attachedthereto. Open clamp portion 210 comprises a clamp opening 216 extendingobliquely relative to the first axis A1, with opening 216 in an offsetplane relative to opening 132 in closed clamp portion 130.

In another alternative embodiment of a connector assembly 300, shown inFIG. 7, wherein an open clamp portion 310 comprises a clamp opening 316extending generally orthogonally relative to first axis A1 such that ablind end of opening 316 extends along first axis A1, allowing theinsertion of rod 50 in opening 316 to be coplanar with rod 70 after rod70 is inserted into passage 132. FIG. 8 shows the connection ofconnector assembly 300 with rod 70 extending in the same lateral planeas existing rod 50. This configuration allows the open clamp portion 310to be positioned beneath the existing rod 50. A threaded cap (not shown)may then be engaged with the threaded portion on the top of the openclamp portion 310 to secure the rod 50 therein, thereby coupling rod 50to rod 70.

In still another embodiment of a connector assembly 400, shown in FIGS.9 and 10, an open clamp portion 410 comprises a clamp opening 416extending generally orthogonally relative to first axis A1 such that ablind end of opening 416 extends above first axis A1, allowing theinsertion of rod 50 in opening 416 to be skewed with respect to rod 70after rod 70 is inserted into passage 132. The open clamp portion 410may have a generally U-shaped configuration allowing for the open clampportion 410 to be positioned beneath the existing rod 50. A threaded cap(not shown) may then be engaged with the threaded portion on the top ofthe open clamp portion 410 to secure the rod 50 therein, therebycoupling existing rod 50 to new rod 70.

In yet another embodiment of a connector assembly 500, shown in FIG. 11,and articulating modular lateral head connector is provided. In thisembodiment, the open clamp portion is replaced with a connection point,such as a post, configured to receive a rod having a modular connectionpoint 1220, for example, as depicted in FIG. 28 and described in moredetail below. The post or connection point may have a partiallyspherical outer surface with a generally flat top surface to enableengagement with a corresponding opening in the rod.

Referring now to FIGS. 12-27, a plurality of integrated revisionconnectors according to exemplary embodiments are shown. In an exemplaryembodiment, shown in FIG. 12, a spinal revision connector assembly 600includes a body 610 having a first end 612 and a second end 614. Body610 is generally a closed loop that provides a space sufficiently largefor the insertion of a pre-existing construct, such as, for example, aspinal implant screw head (not shown) therethrough, thereby minimizingthe amount of new construct that is to be connected to an existingconstruct.

A first connecting member 620 is located at first end 612. In anexemplary embodiment, first connecting member 620 can be a threadedopening that allows for the insertion of a fastener, such as a set screw(not shown), that provides for connection to existing construct.

An upper surface 622 of first end 612 includes an arcuate recess 624sized to accept a rod (not shown) from an existing construct. Similarly,a lower surface 626 includes an arcuate recess 628 sized to accept a rod(not shown) from an existing construct. Recesses 624, 626 can be thesame or different sizes (as shown) in order to be able to accommodaterods of different diameters.

A rod 630 extends from second end 614 of body 610. Rod 630 can have atapered tip 632 at a distal end of rod 630 from body 610. Rod 630 canextend an existing construct two adjacent level in order to providerequired fixation.

In an alternative exemplary embodiment, shown in FIGS. 13-16, a spinalrevision connector assembly 700 includes a body 710 having a first end712 and a second end 714. Body 710 is generally an open loop thatprovides a space sufficiently large for the insertion of body 710 overthe top of a screw head 60 in an existing construct where rod 50 is ofinsufficient length protruding from the side of screw head 60, as shownin FIGS. 14 and 15. Alternatively, body 710 can go around screw head 60in the existing construct, as shown in FIG. 16.

A first connecting member 720 is located at first end 712. In anexemplary embodiment, first connecting member 720 can be one or morethreaded openings 722, 724, that allow for the insertion of a fastener,such as a set screw (not shown), that provides for connection toexisting construct. Additionally, a lower lip 726 is used to support anunderside of rod 50 to provide secure clamping of first connectingmember 720 to rod 50, such that a passage 727 is formed between lowerlip 726 and first end 712.

A rod 730 extends from second end 714 of body 710. Rod 730 can have atapered tip 732 at a distal end of rod 730 from body 710. Rod 730extends along a common axis with passage 727 such that rod 730 extendsthe existing construct of rod 50 at an adjacent level.

In another alternative exemplary embodiment, shown in FIGS. 17 and 18, aspinal revision connector assembly 800 includes a body 800 and having afirst end 812 and a second end 814. Body 810 is generally an open loopwith a space between first end 812 and second end 814 that allows forthe insertion of body 810 over the top of screw head 60 in an existingconstruct where rod 50 is of insufficient length protruding from theside of screw head 60, as shown in FIG. 18. It is noted that, in FIG.18, the length of rod 50 extending beyond screw head 60 is longer thanthat shown in FIG. 14, allowing for the use of assembly 800, as shown inFIG. 18.

A first connecting member 820 is located at first end 812 and a secondconnecting member 822 is located at second end 814. First connectingmember 820 and second connecting member 822 can be threaded openingsthat allow for the insertion of a fastener, such as a set screw (notshown), to secure assembly 800 to rod 50 where rod 50 is sufficientlylong to allow rod 50 to extend beyond screw head 60, such that rod 50can be engaged and secured by second connecting member 822, as shown inFIG. 18. Additionally, a first lower lip 824 at first connecting member820 and a second lower lip 826 at second connecting member 822 are usedto support an underside of rod 50 to provide secure clamping ofconnecting members 820, 822 to rod 50, such that a passage 827 is formedbetween first lower lip 824 and first end 812 and between second lowerlip 826 and second end 814.

A rod 830 extends from second end 814 of body 810. Rod 830 can have atapered tip 832 at a distal end of rod 830 from body 810. Rod 830extends along a common axis with passage 827 such that rod 730 extendsthe existing construct of rod 50 at an adjacent level.

In still another alternative exemplary embodiment, shown in FIG. 19, aspinal revision connector assembly 900 includes a body 910 having afirst end 912 and a second end 914. Body 910 is generally a closed loopthat provides a space between first end 912 and second end 914sufficiently large for the insertion of a pre-existing construct, suchas, for example, screw head 60, therethrough, thereby minimizing theamount of new construct that is to be connected to an existingconstruct.

A first connecting member 920 is located at first end 912 and a secondconnecting member 922 is located at second end 914. First connectingmember 920 and second connecting member 922 can be threaded openingsthat allow for the insertion of a fastener, such as a set screw (notshown), to secure assembly 900 to rod 50 where rod 50 is sufficientlylong to allow rod 50 to extend beyond screw head 60, such that rod 50can be engaged and secured by second connecting member 922.

A rod 930 extends from second end 914 of body 910. Rod 930 can have atapered tip 932 at a distal end of rod 930 from body 910.

In still another alternative exemplary embodiment, shown in FIGS. 20-22,a spinal revision connector assembly 1000 includes a body 1010 having afirst end 1012 and a second end 1014. Body 1010 is generally an openloop that provides a space between first end 1012 and second end 1014that is sufficiently large for the insertion of a pre-existingconstruct, such as, for example, screw head 60, therethrough, therebyminimizing the amount of new construct that is to be connected to anexisting construct. FIG. 21 shows body 1010 extending over top of screwhead 60, while FIG. 22 shows body 1010 extending around screw head 60.

A first connecting member 1020 is located at first end 1012. Firstconnecting member 1020 can be a threaded opening that allows for theinsertion of a fastener, such as a set screw (not shown), to secureassembly 1000 to rod 50. Connecting member 1020 also includes clampingsurfaces 1022, 1024 that extend outwardly from first end 1012. Clampingsurfaces 1022, 1024 are spaced sufficiently from each other to allow rod50 to slide therethrough such that, when the fastener or set screw issecured, first connecting member 1020 securely grips rod 50.

A rod 1030 extends from second end 1014 of body 1010. Rod 1030 can havea tapered tip 1032 at a distal end of rod 1030 from body 1010. Rod 1030extends at the adjacent level as for 50 (shown in FIG. 21).

In another alternative exemplary embodiment, shown in FIGS. 23-27, aspinal revision connector assembly 1100 includes a body 1110 having afirst end 1112 and a second end 1114. First end 112 includes a clamphousing that contains an inner revolving mechanism 1116 that can berotated to surround the underside of an existing rod 50.

Mechanism 1116 includes a rotating clamp 1118 that is mounted on a pivot1120. A distal end of clamp 1118 includes a plurality of ratchet teeth1122. When clamp 1118 is rotated from the position shown in FIG. 24A tothe position shown in FIG. 24D, ratchet teeth 1122 engage a securingmechanism in the form of internal ratchet teeth 1124 within body 1110 tosecure clamp 1118 around rod 50, as shown in FIG. 25, preventing clamp1118 from rotating backwards after final tightening. Clamp 1118 isrotated by rotating mechanism 1120. As shown in FIGS. 24A-24D, rotatingmechanism 1120 can be a hex head screw that can be rotated by engaging ahex head tool, such as, for example, an Allen wrench (not shown), withrotating mechanism 1120 and rotating.

Body 1110 includes arcuate cutouts 1126 on opposing sides thereof (onlyone cutout 1126 shown in FIG. 25), that are sized to receive rod 50 sothat body 1110 snugly fits on rod 50. Body 1110 also includes a threadedtop opening 1128 sized to receive a set screw 1129 inserted therein sothat set screw 1129 can be screwed on top of rod 50, as shown in FIG.26.

A rod 1130 extends from second end 1114 of body 1110. Second end 1114comprises an offset portion 1132 and distal end 1134 extending away fromoffset portion 1132, such that distal end 1134 is at an adjacent levelwith rod 50, as shown in FIG. 27. A space is provided between first end1112 and second end 1114 that is sufficiently large for the insertion ofa pre-existing construct, such as, for example, a spinal implant screwhead (not shown) therethrough, thereby minimizing the amount of newconstruct that is to be connected to an existing construct.

Referring now to FIGS. 28-38, a plurality of link connectors accordingto exemplary embodiments are shown. A first exemplary link connector1200 is used with a mating modular connection point on a spinal screw,or a secondary connector implant.

Referring specifically to FIGS. 28 and 29, a connector 1200 includes arod 1210 within modular connection point 1220 at a first end. Connectionpoint 1220 is a generally hollow body. Also, connection point 1220includes a threaded connector, such as, for example, a fastener or setscrew 1222 rotatably connected thereto and extending into the hollowbody of connection point 1220. Additionally, connection point 1220includes a diametrically opposed indents 1224 (only one indent 1224shown in FIG. 28) to accommodate a gripping tool, such as, for example,a spanner wrench (not shown) that can be used to secure rod 1210 at adesired position while set screw 1220 is being tightened.

FIG. 29 shows connector 1200 spanning screw heads 60, 62. Connectionpoint 1220 is secured directly to screw 62, while rod 1210 is secured toscrew head 60, placed at an adjacent level.

Referring to FIG. 30, an exemplary embodiment of a lateral connector1300 is shown. Lateral connector 1300 includes a base 1310 having afirst end 1312 with a connection point 1314 extending upwardlytherefrom. Connection point 1314 is sized to fit into connection point1220 and receives set screw 1222 from link connector 1200.

Base 1310 also has a second end 1320 that includes a rod clamp 1322. Rodclamp 1322 includes an arcuate surface 1324 for engaging a rod and a topsurface 1326, extending above connection point 1314, that supports asecuring member, such as, for example, a set screw 1328 that can berotated to secure rod 50 within rod clamp 1322, as shown in FIG. 32. Asshown in FIG. 32, rod 1210 can extend at an oblique angle relative torod 50, in order to accommodate for the lateral offset in lateralconnector 1300.

Referring to FIG. 31, a top loading connector 1400 is shown. Connector1400 includes a body 1410 that includes a rod clamp 1412. Rod clamp 1412includes an arcuate surface 1414 for engaging a rod and a flat topsurface 1416 disposed above arcuate surface 1414. Top surface 1416includes a first threaded connection 1418 that receives a set screw1420. Top surface 1416 also includes a second threaded connection 1422,for receiving an additional connector (not shown).

Referring now to FIGS. 33 and 34, a lateral offset link connector 1500is shown. Link connector 1500 is similar to link connector 1200, withthe exception that, instead of a straight elongate body 1210, linkconnector 1500 includes a body 1510 having a first end 1512 connected toa modular connection point 1520, similar to modular connection point1220, a second, free end, 1514, and a lateral offset 1516, connectingfirst end 1512 with second end 1514. Lateral offset 1516 is sized toaccommodate the same lateral offset as with lateral connector 1300.

As shown in FIG. 34, modular connection point 1520 can be connected tolateral connector 1300, which in turn is connected to a rod 50 in anexisting construct such that second end 1514 extends generallyco-linearly with rod 50, thereby allowing second end 1514, toeffectively act as an extension of rod 50.

Referring now to FIGS. 35 and 36, a sagittal offset link connector 1600is shown. Link connector 1600 is similar to link connector 1500, withthe exception that, instead of lateral offset 1516, link connector 1600includes a body 1610 having a first end 1612 connected to modularconnection point 1620, similar to modular connection point 1520, asecond, free end, 1614, and a sagittal offset 1616, connecting first end1612 with second end 1614. Sagittal offset 1616 is sized to allowconnector 1600 to extend upward and over a screw head 60 when connectedto a lateral connector 1300 and rod 50, as shown in FIG. 36.

As shown in FIG. 36, modular connection point 1620 can be connected tolateral connector 1300, which in turn is connected to a rod 50 in anexisting construct such that second end 1614 extends generallyco-linearly with rod 50, thereby allowing second end 1514, toeffectively act as an extension of rod 50.

Referring now to FIGS. 37-57, a plurality of link connectors accordingto exemplary embodiments are shown. FIGS. 37-41 show a connector 1700according to an exemplary embodiment. Connector 1700 is connected to anexisting rod by a twisting connection and subsequent to attachment, asecond, new rod may be positioned above and in-line with the existingrod. For example, connector 1700 may be inserted between two existingscrew head 60, proximal to an adjacent level that needs additionalfixation.

Connector 1700 includes a body 1710 having a connecting portion 1712 ata first end and a screw head portion 1720 at an opposing end. Connectingportion 1712 includes a pair of outwardly extending curved legs 1714,1716 that extend downwardly from diametrically opposed sides of body1710 in opposing directions, forming a passage 1718 sized to allow a rod50 to extend therethrough.

Screw head portion 1720 includes a first arcuate portion 1722 and asecond arcuate portion 1724 diametrically opposed from first arcuateportion 1722, forming a rod through-passage 1725 extending therebetween.The interior faces of each of arcuate portion 1722, 1724 are threaded atthreads 1726 to accommodate insertion of a set screw 1730, shown in FIG.41.

To install connector 1700 on a rod 50, connector 1700 is inserted withrod through-hole 1725 facing in a medial/lateral direction and legs1714, 1716 straddling rod 50, as shown in FIG. 40. Connector 1700 isthen rotated 90° in situ, so that rod 50 extends through passage 1718,with legs 1714, 1716 extending underneath rod 50, as shown in FIG. 41.Set screw 1730 is then screwed downward to engage rod 50, securingconnector 1700 to rod 50.

In an alternative embodiment of a connector 1800, shown in FIG. 42,instead of threads 1726 and set screw 1730, lower interior surfaces of afirst arcuate portion 1822 and a second arcuate portion 1824 areunthreaded and a wedge 1826 is advanced through a rod through-passage1825 to engage rod 50 and secure rod 50 to connector 1800.

As shown in FIG. 43, either connector 1700 or connector 1800 can beattached to an existing rod 50 through passage 1718 and a new constructwith a rod 80 can be inserted through rod through-passage 1725, 1825. Athreaded cap (not shown) may then be engaged with the threaded portionon the top of the screw head portion 1720 to secure the rod 80 therein,thereby achieving fixation. If required, rod 80 can be bent to maintainnew construct and an adjacent level with the existing rod 50.

FIGS. 44-46 show a connector 1900 according to an exemplary embodiment.Connector 1900 includes a body 1910 having a connecting portion 1912 ata first end and a head portion 1930 at an opposing end. Connectingportion 1912 includes a first generally longitudinally extending leg1914 having a connection mechanism 1916 extending therethrough. In anexemplary embodiment, connection mechanism 1916 can be a set screw.

Connecting portion 1912 also includes a second leg 1917, having a firstportion 1918 that extends generally longitudinally away from body 1910,generally parallel to first leg 1914. Second leg 1917 also includes acurved portion 1919 that curves an arcuate fashion toward first leg1914, forming a passage 1920 therebetween. Passage 1920 is sized toallow connector 1900 to be connected to an existing rod 50, as shown inFIG. 46. Connection mechanism 1916 extends sufficiently through firstleg 1914 to be able to extend into passage 1920.

Head portion 1930 includes a first arcuate portion 1932 and a secondarcuate portion 1934 diametrically opposed from first arcuate portion1932, forming a rod through-passage 1935 extending therebetween. Rodthrough-passage 1935 is sized to receive a rod 80 as part of a newlyassembled construct, as shown in FIG. 46. If rod 80 is a “Z-Rod”, rod 80can be configured to achieve fixation at an adjacent level with rod 50.

FIGS. 47-50 show a connector 2000 according to an alternative exemplaryembodiment. Connector 2000 is similar to connector 1900 as describedabove, with the exception that connector 2000 includes only a single leg2017 extending downward from a body 2010. Leg 2017 includes a firstportion 2018 that extends longitudinally outwardly, away from body 2010and a curved portion 2019 that curves in an open hook fashion toward anopposing side of body 2010, forming an open passage 2020. Curved portion2019 includes an arcuate support face 2021 faces open passage 2020 andserves as a support for an existing rod 50, as shown in FIG. 50.

FIG. 48 shows connector 2000 with an optional set screw 2030 can bethreaded into a threaded passage 2032 to secure connector 2002 existingconstruct, such as, for example, rod 50.

Alternatively, FIG. 49 shows connector 2000 and optional wedge 2040 thatcan be used in place of set screw 2030, to secure rod 50 in connector2000.

Similarly to connector 1900, connector 2000 has a rod through-passage2035 is sized to receive a rod 80 as part of a newly assembledconstruct, as shown in FIG. 50. If rod 80 is a “Z-Rod”, rod 80 can beconfigured to achieve fixation at an adjacent level with rod 50.

Lateral connector 1300, shown previously in FIG. 30, can be used asshown in FIG. 51 to connect to a rod 50 in an existing construct. Asshown in FIGS. 52-54, new construct 90 can be attached at connectionpoint 1314 to achieve fixation. Instead of installing connector 1200 atan angle, as shown in FIG. 32, FIGS. 53 and 54 show that, when rod 80 isa Z-Rod, lateral connector 1300 can be used to support rod 80 such therod 80 extends collinear with existing rod 50.

Top loading connector 1400, shown previously in FIG. 31, can be used. Asshown in FIGS. 55-57 to connect to an existing rod 50. In an existingconstruct. As shown in FIGS. 56 and 57, new construct 90 can be attachedat connection 1422 to achieve fixation. As will be appreciated by thoseskilled in the art, after the rod 80 is secured and attached to theexisting rod 50 and the adjacent vertebra or vertebrae using a minimallyinvasive surgical (MIS) approach, the extensions may be detached fromthe tulips, thereby leaving the connector 1400 and rod 80 subcutaneouslyimplanted in the patient.

Referring now to FIGS. 58 and 59, an offset revision rod 2100 accordingto an exemplary embodiment is shown. Revision rod 2100 has an elongatebody 2110 having a first end 2112, with an integrated single open clamp2120 extending laterally therefrom. Claim 2120 includes a body 2122 witha clamp portion 2124 sized to accept and retain a rod (not shown)between proximal existing screw heads (also not shown). Body 2122 alsoincludes a threaded opening 2126 sized to accept a fastener, such as aset screw (not shown), that can be screwed downwardly to secure the rodinto clamp portion 2124.

Body 2110 further has a second end 2130 an offset 2132, between firstend 2112 and second and 2130, such that first and 2112 and second end2130 extend parallel to each other. Rod 2100 allows a fixation to beextended to adjacent level with a single implant. Offset 2132 allows rod2100 to navigate around a most proximal screw head (not shown) in anexisting construct.

A distraction/compression clamp 2200 is shown in FIGS. 60-61. Clamp 2200has a single open clamp 2210 with a through passage 2212 sized to accepta rod 50 inserted therethrough. Claim 2200 also includes a threadedopening 2220 that is sized to accept a set screw 2222 to secure clamp2200 to rod 50. Clamp 2200 can provide a fixed point for distractionand/or compression.

A double-headed lateral connector 2300 is shown in FIGS. 62-64.Connector 2300 includes a body 2310 having a first screw head 2320(e.g., a first tulip) having a passage 2322 and a second screw head 2330(e.g., a second tulip) having a passage 2332. Screw heads 2320 and 2330are separated from each other by a connecting member 2340. Passage 2322is sized to accept a first rod (not shown) from an existing constructand passage 2332 is sized to accept a second rod (not shown) from thenew construct in order to extend the existing construct to an adjacentlevel. A threaded cap (not shown) may then be engaged with each of thethreaded portions on the tops of the screw heads 2320 and 2330 to securethe respective rods therein, thereby coupling the rods substantiallyparallel to one another. While FIG. 62 shows screw heads 2320, 2330extending parallel to each other, those skilled in the art willrecognize that screw heads 2320, 2330 can also be offset or angledrelative to each other.

While FIG. 62 shows connecting member 2340 connecting first screw head2320 and second screw head 2330 only at the bottom portion of connector2300, FIGS. 63 and 64 show a connecting member 2350 that connects firstscrew head 2320 and second screw head 2330 along the length of the screwheads.

FIG. 65 shows a double-headed in-line connector 2400 according to anexemplary embodiment. While lateral connector 2300 discussed abovelaterally connects adjacent rods, in-line connector 2400 connectsadjacent rods longitudinally. Connector 2400 includes a body 2410 havinga first screw head 2420 having a passage 2422 and a second screw head2430 having a passage 2432. Screw heads 2420 and 2430 are separated fromeach other by a connecting member 2440. Passage 2422 is sized to accepta rod (not shown) from an existing construct and passage 2432 is sizedto accept a rod (not shown) from the new construct in order to extendexisting construct to an adjacent level. A threaded cap (not shown) maythen be engaged with each of the threaded portions on the tops of thescrew heads 2420 and 2430 to secure the respective rods therein, therebycoupling the rods substantially in-line with one another. While FIG. 65shows screw heads 2420, 2430 extending parallel to each other, thoseskilled in the art will recognize that screw heads 2420, 2430 can alsobe offset or angled relative to each other.

A J-hook connector 2500 according to an exemplary embodiment is shown inFIG. 66. Connector 2500 includes an elongate body 2510 having a firstend 2512 and a second end 2514. First end 2512 includes an open clamp2520 attached thereto. Clamp 2520 includes a passage 2522 sized to allowa rod (not shown) to be inserted therethrough. Clamp 2520 also includesa threaded opening 2524 sized to allow a set screw (not shown) to beinserted therethrough to secure the rod within opening 2524.

Connector 2500 is used to connect a rod (not shown) on a first side of apatient's spine with first end 2512, and to insert second end 2514 intoa screw head (not shown) on an opposing side of the patient's spine.

A parallel connector 2600 according to an exemplary embodiment is shownin FIGS. 67 and 68. Connector 2600 includes a body 2610 having agenerally oblong opening 2612 that is sized to allow the insertion of 2rods 50, 50′ therethrough to extend the length of rod 50, with rod 50′.As shown in FIG. 68, a single set screw 2620 extends through body 2610between rods 50, 50′ to secure rods 50, 50′ to connector 2600. While asingle set screw 2600 is shown, those skilled in the art will recognizethat to set screws, one located above each of rod 50, 50′, can be usedto secure rods 50, 50′, respectively, to connector 2600.

FIG. 69 shows a single open head lateral connector 2700 according to anexemplary embodiment. Connector 2700 includes an open clamp 2710 and anadjacent screw head 2720, coupled to each other by a connector 2730.

Open clamp 2710 includes an arcuate portion 2712, forming athrough-passage 2713 that is sized to accept a rod (not shown) from anexisting construct inserted therein. Open clamp 2710 also includes athreaded opening 2714 sized to accept a set screw (not shown) that canbe threaded into through-passage 2713 to secure the rod inthrough-passage 2713.

Screw head 2720 includes a passage 2722 that is sized to allow theinsertion of a rod (not shown) in new construct therein. Through-passage2713 and passage 2722 extend in a common plane such that the rod in thenew construct is at the same level as the rod in the existing construct.

FIG. 70 shows a double modular lateral connector 2800 according to anexemplary embodiment. Connector 2800 includes an elongate body 2810having a first end 2812 and a second end 2814, distal from first end2812. Each end 2812, 2814 includes a point of attachment 2820, 2822,respectively for the attachment of modular screw heads side-by-side, asshown, allowing for options variety of screw heads. Each point ofattachment 2820, 2822 may be in the form of a post having apartially-spherical outer surface with a substantially flatten topsurface having one or more recesses therein. In one embodiment, a tulipcan be placed on attachment point 2820 before or after connecting to anexisting rod (not shown). The new rod (not shown) can then beintroduced, for example, in a second tulip attached to attachment point2822 in order to extend the fixation at an adjacent level. In thealternative, a rod 1200, for example, shown in FIG. 28, with anintegrated attachment point 1220 can connect to one or more of the postson connector 2800. While connection points 2820 and 2822 are shown asbeing parallel to each other, those skilled in the art will recognizethat connection points 2820, 2822 can also be offset or angled relativeto each other.

FIG. 71 shows a Z-rod 80 according to an exemplary embodiment. As shownpreviously throughout, rod 80 is used to link to an existing constructat an adjacent level. Rod 80 includes a generally elongate body 82having a first end, a second end 86, distal from first end 84, and abent portion 88, located along body 82, between first and 84 and secondend 86. The position and offset distance of bend portion 88 can bevaried depending upon the location of existing construct and theparticular patient anatomy.

FIG. 72 shows an in-line connector with an integrated rod 3000 accordingto an exemplary embodiment. Rod 3000 includes an elongate body 3010having a first end 3012 and a second end 3014, distal from first end3012. A closed connector 3020 is attached to first end 3012. Connector3020 includes an opening 3022, in line with, and, distal from body 3010into which an existing rod (not shown) is inserted to extend the lengthof an existing construct at an adjacent level. Then one or morefasteners or set screws (not shown) may be positioned in the one or moreopenings in the connector portion 3020 to secure the existing rodtherein, thereby coupling the new rod extension to the existing rodconstruct.

FIGS. 73 and 74 show a top loading connector 3100 according to anexemplary embodiment. Connector 3100 is a top loading lateral connectorthat has a body 3102 having two clamping portions that are laterallyoffset from each other. A first clamping portion 3110 has a first axialpassage 3112 having a first longitudinal axis 3114 extendingtherethrough. Referring to FIG. 74, axis 3114 extends perpendicularlyoutwardly from the plane of the paper of the Figure.

First passage 3112 is sized to allow a first rod, such as a rod 70(shown in FIG. 3) to be inserted thereinto. First passage 3112 isgenerally U-shaped and has a closed top portion 3113 that has agenerally arcuate top wall 3115 and a bottom portion having an opening3116 in communication with the rest of first passage 3112. Opening 3116is defined by generally parallel opposing sidewalls 3118, 3120 thatextend at an angle oblique to the vertical relative to body 3102 asshown in FIG. 74.

Opening 3114 is sufficiently large to allow opening 3114 to extend overrod 70 such that first clamping portion 3110 can be placed over rod 70and slid over rod 70 until rod 70 is located in top portion 3113, asshown in FIG. 74.

A first securing mechanism 3122 is rotatably connected to first clampingportion 3110 and is adapted to extend into first passage 3112 toreleasably secure first rod 70 in first passage 3112. First securingmechanism 3122 includes a threaded through-hole 3124 extending throughbody 3102 to first passage 3112 and a set screw 3126 that is rotatablyinserted into through-hole 3124. A first end 3128 of set screw 3126includes a threaded exterior 3127 that threadingly engages threadedthrough-hole 3124. First end 3128 of set screw 3126 also includes areceiver 3129, such as, for example, for an Allen wrench or a Torx®wrench, and an engagement end 3130 that extends into first passage 3112to bias rod 70 against top wall 3115 in top portion 3113 to secureconnector 3100 to rod 70.

Set screw 3126 also includes a securing channel 3132 that extends arounda periphery of set screw 3126 between first end 3128 and securing end3130. Securing channel 3132 includes a flared portion 3133 at a bottomend thereof. A retaining pin 3134 extends through body 3102 generallyparallel to axis 3114 such that retaining pin 3134 extends throughsecuring channel 3132 between set screw 3126 and through-hole 3124 andbetween threaded exterior 3127 and flared portion 3133 such that flaredportion 3133 is stopped by retaining pin 3134 if set screw 3126 isattempted to be removed from body 3102.

Set screw 3126 extends at an angle oblique to the horizontal. Set screw3126 can be angled at such an angle to give the implanting physician abetter angle to access set screw 3126 than if set screw 3126 extended ina horizontal plane.

A second clamping portion 3150 has a second passage 3151 that has asecond longitudinal axis 3154 extending therethrough. Second passage3151 comprises a generally circular axial passage, or through-opening,3153. Second longitudinal axis 3154 is parallel to first longitudinalaxis 3114, and is sized to allow a second rod, such as, for example, arod 80 shown in FIG. 71, to be inserted thereinto along secondlongitudinal axis 3154.

Similar to first clamping portion 3110, second clamping portion 3150incudes a second securing mechanism 3152 that is adapted to releasablysecure second rod 80 in second passage 3153. Second securing mechanism3150 includes a threaded through-hole 3155 and a set screw 3156 that isrotatably inserted into through-hole 3124. A first end 3158 of set screw3156 includes a threaded exterior 3157 that threadingly engages threadedthrough-hole 3155. First end 3158 of set screw 3156 also includes areceiver 3159, such as, for example, for an Allen wrench or a Torx®wrench, and an engagement end 3160 that extends into second passage 3151to bias a rod 80 (not shown) against the wall of through-opening 3153 tosecure connector 3100 to rod 80.

A shown in FIG. 74, first clamping portion 3120 has a height “A” andsecond clamping portion 3150 has a height “B” that is higher than height“A”.

Connector 3100 can be used to add a new construct to an existingconstruct. By way of example only, opening 3114 can be inserted overinserting first rod 70 in an existing construct. First connectingportion 3110 can be secured to first rod 70 by rotating securingmechanism 3122 and advancing securing mechanism 3122 into axial passage3112 to secure first connecting portion 3110 to first rod 70. Second rod80 can be inserted through through-opening 3153 and secured by set screw3156.

An alternative embodiment of a connector 3200 is shown in FIG. 75.Connector 3200 is similar to connector 3100 with the exception of secondconnecting portion 3250, which differs from second connecting portion3150 in connector 3100 as described below.

Instead of generally circular passage 3151, in connector 3200, a secondconnector portion 3250 has second passage 3251 with an opening 3252defined by a generally U-shaped wall 3253 that allows connector 3200 tobe inserted over second rod 80 (not shown) instead of requiring secondrod 80 to slide through passage 3251. Also, connector 3200 can bereversed such that second connecting portion 3250 can be secured toexisting rod 70 and first connecting portion 3110 can be secured to anew construct, such as rod 80.

A securing mechanism 3252 uses a different set screw 3256 than set screw3156. Set screw 3256 has an engagement end 3260 having a taperedperimeter 3258 such that tapered perimeter 3258 engages second rod 80and biases second rod 80 against wall 3153.

Another alternative embodiment of a connector 3300 is shown in FIG. 76.Connector 3300 is similar to connector 3100 with the exception of secondconnecting portion 3350, which differs from second connecting portion3150 in connector 3100 as described below. In an exemplary embodiment,second connection portion 3350 can be a “tulip style” connection, as isrecognized by those skilled in the art.

Second connecting portion 3350 has a second passage 3352 with agenerally U-shaped opening 3354 that opens at the top of secondconnecting portion 3350 and has a closed bottom wall 3353 that isarcuate in shape. Opening 3354 is defined by bottom wall 3353 andopposing generally planar side walls 3356, 3358 that each includethreads 3360, 3362, respectively, that extend away from their respectivewalls 3356, 3338. Threads 3360, 3362 are used to receive a securingmember, such as set screw 3256 (shown in FIG. 75).

Opening 3354 allows for the insertion of rod 80 (not shown), which has acircular cross-section, or some other construct with a non-circularcross-section, such as an oblong cross-section.

Another alternative embodiment of a sliding member top loading connector3400 is shown in FIGS. 77-78. Connector 3400 is similar to connector3100 with the exception of first connecting portion 3410, which differsfrom first connecting portion 3110 in connector 3100 as described below.

First connecting portion 3410 includes an open first passage 3412defined by an arcuate wall 3414 that allows connector 3400 to be placedover a member, such as rod 70 (shown in FIG. 78), in an existingconstruct to add on to the existing construct.

First connecting portion 3410 includes a securing mechanism 3422 havinga locking portion in the form of a member 3420 that is extendible intofirst passage 3412. Member 3420 is translatably located in a horizontalpassage 3411 that communicates with first passage 3412.

Member 3420 is a generally cylindrical member that is longitudinallytranslatable between a first rod unlocking position and a first rodlocking position to releasably secure rod 70 against generally arcuatewall 3414 that defines first passage 3412. Member 3420 has a rodengaging surface 3424 that engages rod 70 and biases rod 70 against wall3414. Rod engaging surface 3424 is angled with respect to the horizontalsuch that, as member 3420 is translated from the rod unlocking positionto the rod locking position (as shown in FIG. 78), rod 70 slides up rodengaging surface 3424 to provide a secure connection between connector3400 and rod 70.

Member 3420 also includes a cam surface 3430 that is acted upon to movemember 3420. In an exemplary embodiment, cam surface 3430 is an arcuatesurface, although those skilled in the art will recognize that camsurface 3430 can be another shape, such as for example, a slopedsurface, so that, when cam surface 3430 is acted upon by another memberfrom above, member 3420 translates into passage 3412.

Member 3420 includes a longitudinal slot 3432 that extends within member3420 between rod engaging surface 3424 and cam surface 3430. A retainingpin 3436 extends through slot 3432 and retains member 3420 withinhorizontal passage 3411.

Securing mechanism 3422 also includes a rotating portion in the form ofa set screw 3440 that is adapted to engage cam surface 3430 of member3420 such that member 3420 is longitudinally translatable intoengagement with first rod 70. Set screw 3440 is threadingly mounted in athreaded screw passage 3442 that is in communication with horizontalpassage 3411. Set screw 3440 includes a first end 3444 having a receiver3446, such as, for example, for an Allen wrench or a Torx® wrench, andan engagement end 3448 having a tapered tip 3450 such that, as set screw3440 is screwed downwardly into screw passage 3442, tapered tip 3450engages cam surface 3430 and longitudinally translates member 3420 intopassage 3412 and into engagement with rod 70.

Still another alternative embodiment of a pivoting member top loadingconnector 3500 is shown in FIGS. 79-80. Connector 3500 is similar toconnector 3100 with the exception of first connecting portion 3510,which differs from first connecting portion 3110 in connector 3100 asdescribed below.

First connecting portion 3510 includes an open first passage 3512defined by an arcuate wall 3514 that allows connector 3500 to be placedover a member, such as rod 70 (shown in FIG. 80), in an existingconstruct to add on to the existing construct.

First connecting portion 3510 includes a securing mechanism 3522 havinga locking portion in the form of a member 3520 that is extendible intofirst passage 3512. Member 3520 is pivotally located in a pivot memberpassage 3511 that communicates with first passage 3512.

Member 3520 is a generally inverted “V-shaped” member that is pivotableabout a pivot point 3521 in pivot member passage 3511 between a firstrod unlocking position and a first rod locking position to releasablysecure rod 70 in first passage 3512. Member 3520 has a rod engagingsurface 3524 (a first leg of the “V”) that engages rod 70 and biases rod70 against wall 3514. Rod engaging surface 3524 can have at least aslightly arcuate profile such that, as member 3520 is pivoted from therod unlocking position to the rod locking position (as shown in FIG.80), rod engaging surface 3524 “cups” rod 70 to provide a secureconnection between connector 3500 and rod 70. Member 3520 also includesa cam surface 3530 as the remaining leg of the “V” that is acted upon topivot member 3520.

Securing mechanism 3522 also includes a rotating portion in the form ofa set screw 3540 that is adapted to engage cam surface 3530 of member3520 such that member 3520 is pivoted about pivot pin 3521, pivoting rodengaging surface 3524 into engagement with first rod 70. Set screw 3540is threadingly mounted in a threaded screw passage 3542 that is incommunication with pivot member passage 3511. Set screw 3540 includes afirst end 3544 having a receiver 3546, such as, for example, for anAllen wrench or a Torx® wrench, and an engagement end 3548 having atapered tip 3550 such that, as set screw 3540 is screwed downwardly intoscrew passage 3542, tapered tip 3550 engages cam surface 3530 and pivotsmember 3520 into passage 3512 and into engagement with rod 70.

Yet another alternative embodiment of a cam lock top loading connector3600 is shown in FIGS. 80-85. Connector 3600 is similar to connector3100 with the exception of first connecting portion 3610, which differsfrom first connecting portion 3110 in connector 3100 as described below.

First connecting portion 3610 includes an open first passage 3612defined by an arcuate wall 3614 that allows connector 3600 to be placedover a member, such as rod 70 (shown in FIGS. 82-85), in an existingconstruct to add on to the existing construct.

First connecting portion 3610 includes a securing mechanism 3622 havinga locking portion in the form of a member 3620 that is rotatablyextendible into first passage 3612. Member 3620 is rotatably located ina vertical passage 3611 that communicates with first passage 3612.

Member 3620 includes a round portion 3624 having an axis 3626 that isoff-center of the axis of rotation of member 3620 as shown in FIGS. 84and 85. Rotation of member 3620 to the position shown in FIGS. 82 and 84causes round portion 3624 to rotate off center, allowing rod 70 to beuntouched and unsecured within first passage 3612. Rotation of member3620 to the position shown in FIGS. 83 and 85 causes round portion 3624to rotate to the securing position, biasing rod 70 against wall 3614 offirst passage 3612.

An exemplary top loading modular connector 3700 is shown in FIGS. 86-91.Connector 3700 includes a threaded shaft 3710, a clamp sleeve 3740 thatslides over threaded shaft 3710, a clamp body 3770 that is fit overclamp sleeve 3740, and a locking nut 3790 that secures clamp sleeve 3740and clamp body 3770 onto threaded shaft 3710.

Threaded shaft 3710 has an elongate body 3712 having a top loadingclamping portion 3714 and a connection end 3716 on top of clampingportion 3714. Clamping portion 3714 includes a pair of legs 3718, 3720,each having an arcuate cutout 3722, 3724, respectively, that, whenpressed together, form a generally semi-circular surface 3726. Each leg3718, 3720 includes an outwardly flared portion 3719, 3721,respectively, that is engaged by clamp sleeve 3740 when clamp sleeve3740 is compressed downwardly toward clamping portion 3714, such thatflared portions 3719, 3721 are biased toward each other so that legs3718, 3720 grip rod 70.

The diameter of surface 3726 is less than the diameter of rod 70. Aflexure cut 3728 with a relief cut 3730 at a top end thereof allowsclamping portion 3714 to open and clamp around rod 70. A central portion3732 of threaded shaft 3710 has external threads 3734 that threadinglyengage lock nut 3790.

Clamp sleeve 3740 has a generally annular body 3742 with a generallycircular diametric opening 3744 that is larger than the diameter ofcentral portion 3732 of threaded shaft 3710 such that clamp sleeve 3740can be slid over central portion 3732. Clamp sleeve 3740 includes a pairof diametrically opposed clamp legs 3746, 3748 that extend downwardlyfrom body 3742. Each leg 3746, 3748 has a tapered interior cutout 3750,5752, respectively, that engages flared portions 3721, 3719,respectively, to bias flared portions 3719, 3721 toward each other toengage rod 70.

Body 3742 also includes an elongate detent 3754 on either side of body3742 between legs 3746, 3748. Detents 3754 each receive a correspondingtang (not shown) on clamp body 3770 to releasably secure clamp body 3770to clamp sleeve 3740 when locking nut 3790 is threaded onto threadedshaft 3710.

Clamp body 3770 has a generally annular body 3772 with a generallycircular diametric opening 3774 that is larger than the diameter ofcentral portion 3732 of threaded shaft 3710 such that clamp body 3770can be slid over central portion 3732. Clamp body 3770 includes a pairof diametrically opposed tang lips 3776 (only one tang lip 3776 shown inFIG. 87) with a tang (not shown) that extends into a respective detent3754 in clamp sleeve 3740 to secure clamp sleeve 3740 to clamp body 3770and restrict rotation of clamp sleeve 3740 about threaded shaft 3710when locking nut 3790 is threaded onto threaded shaft 3710.

Locking nut 3790 has a body 3792 and a central opening 3794 defined byinternal threads 3796 that threadingly engage threads 3734 on threadedshaft 3710.

In a loading position, as shown in FIG. 88, clamp sleeve 3740 is free tomove about clamping portion 3714 of threaded shaft 3710 to allowclamping portion 3714 to flex and accept rod 70. When locking nut 3790is threaded downwardly onto threads 3734 to the position shown in FIG.89, locking nut 3790 forces clamp body 3770 downward over clamp sleeve3740, which in turn forces clamp sleeve 3740 downward along legs 3718,3720 of threaded shaft 3710, biasing legs 3718, 3720 toward each other,and gripping rod 70.

As shown in FIGS. 90 and 91, clamping portion 3714 can be attached to anexisting rod 70 from above while connection end 3716 serves as theattachment point for a screw tulip 72 (shown in FIG. 90), a connectorrod 1600 (shown in FIG. 91), or other suitable construct in order toextend fixation to an adjacent level.

Another exemplary top loading modular connector 3800 is shown in FIGS.92-97. Connector 3800 includes a clamp shaft 3810 and an outer sleeve3750 that slides over clamp shaft 3810.

Clamp shaft 3810 has an elongate body 3812 having a top loading clampingportion 3814 and a connection end 3816 on top of clamping portion 3814.Clamping portion 3814 includes a pair of legs 3818, 3820, each having anarcuate cutout 3822, 3824, respectively, that, when pressed together,form a generally semi-circular surface 3826. Each leg 3818, 3820 isflared outwardly from a central portion 3832 of clamp shaft 3810 with agenerally convex surface. Central portion 3832 of clamp shaft 3810 has afirst diameter, smaller than the diameter of clamping portion 3814.

Each leg 3818, 3820 also includes an outwardly flared lower nub 3819,3821, respectively, that is engaged by outer sleeve 3850 when outersleeve 3850 is compressed downwardly toward clamping portion 3814, suchthat flared lower nubs 3819, 3821 grip outer sleeve 3850 and so thatlegs 3818, 3820 are biased toward each other, resulting in legs 3818,3820 gripping rod 70. Also, each leg 3818, 3820 also includes anoutwardly flared upper nub 3823, 3825,

The diameter of surface 3826 is less than the diameter of rod 70. Aflexure cut 3828 with a relief cut 3830 at a top end thereof allowsclamping portion 3814 to open and clamp around rod 70.

Clamp shaft 3850 has a generally annular body 3852 with a generallycircular diametric lower opening 3854 that is slightly smaller than thediameter of clamping portion 3814 at the lower end of legs 3818, 3820and a generally circular diametric upper opening 3855 that is largerthan the diameter of connection end 3816 such that clamp shaft 3850 canbe slid over connection end 3816.

Clamp shaft 3850 includes a pair of diametrically opposed shaft legs3856, 3858 that extend downwardly from body 3742. Each leg 3856, 3858has a tapered interior protrusion 3860, 5862, respectively, that engageslower nubs 3819, 3821 respectively, to bias legs 3818, 3820 toward eachother to engage rod 70. Upper nubs 3823, 3825 keep outer sleeve 3850from easily being pulled upwardly off clamp shaft 3810.

In a loading position, as shown in FIG. 94, outer sleeve 3850 is free tomove about clamp shaft 3810 to allow clamping portion 3814 to flex andaccept rod 70. When outer sleeve 3850 is advanced downwardly over lowernubs 3819, 3821 to the position shown in FIG. 95, shaft legs 3856, 3858bias legs 3818, 3820 toward each other, and gripping rod 70.

As shown in FIGS. 96 and 97, clamping portion 3814 is attached to anexisting rod 70 from above while connection end 3816 serves as theattachment point for a screw tulip 72 (shown in FIG. 96), a connectorrod 1600 (shown in FIG. 97), or other suitable construct, in order toextend fixation to an adjacent level.

Turning now to FIGS. 98A-98G, a top loading connector 3900 according toyet another embodiment is shown. Top loading connector 3900 is similarto the top loading connector 3100 shown in FIGS. 73 and 74 except that aclamping mechanism has been added to secure the rod 70 therein.

Connector 3900 is a top loading connector having a closed portion. Theconnector 3900 has a body 3902 having two clamping portions that arelaterally offset from each other. A first clamping portion 3910configured for attaching to a first spinal rod 50, 70 from above, and asecond clamping portion 3950 for attaching to a second spinal rod 50, 70through a closed passage.

The first clamping portion 3910 has a first axial passage 3912 having afirst longitudinal axis 3914 extending therethrough. Referring to FIG.98B, axis 3914 extends perpendicularly outwardly from the plane of thepaper of the Figure. First passage 3912 is sized to allow a first rod,such as rod 50 or 70, to be inserted thereinto. First passage 3912 maybe generally U-shaped and has a closed top portion 3913 that has agenerally arcuate top wall 3915. As best seen in FIG. 98E, opening 3912is defined by generally opposing sidewalls 3918, 3920. The opposingsidewalls 3918, 3920 may be include one or more parallel and/or angledsurfaces configured to receive a portion of a first securing mechanism3922.

The first securing mechanism 3922 includes a locking set screw 3926 anda clamp 3940. Clamp 3940 includes a pair of legs 3942, 3944. Theclamping legs 3942, 3944 are configured to receive a portion of the rod50, 70 therein. The clamping legs 3942, 3944 may each have an arcuatecutout, respectively, that generally define a semi-circular surface.Inner surfaces on the opposing legs 3942, 3944 of the clamp 3940 may betextured, for example, to enhance the connection between the first rod50, 70 and the clamp 3940. The locking set screw 3926 is engaged with anupper portion of the clamp 3940. For example, the engagement end 3930 ofthe locking set screw 3926 may include an annular protrusion configuredto be received in a corresponding recess 3946 in the clamp 3940. Thelocking set screw 3926 may be free to rotate relative to the clamp 3940.

The first securing mechanism 3922 is rotatably connected to firstclamping portion 3910 to releasably secure first rod 50 or 70 in firstpassage 3912. The set screw 3926 includes a threaded exterior thatthreadingly engages threaded through-hole 3924. One end of set screw3926 includes a receiver opening 3929, such as, for example, for anAllen wrench or a Torx® wrench, and the engagement end 3930 thatconnects to the clamp 3940. The threaded set screw 3926 is able torotate independently from the clamp 3940. The threaded set screw 3926threads into the main body 3902 of the connector 3900 from the bottom,allowing the clamp 3940 to translate vertically within the main body3902. A cutout in the main body 3902, forming opposing sidewalls 3918,3920, is angled such that the width of the cutout decreases from thebottom of the main body upward. Therefore, when the clamp 3940translates upward, the wall of the cutout in the main body 3902 contactsthe outer edges of the clamp 3940.

FIG. 98G shows the clamp 3940 in an unlocked position. The configurationof the body of the clamp 3940 allows the clamp 3940 to plasticallydeform, decreasing the size of the opening 3948 accepting the spinal rod50, 70. If desired, a relief cut may further be provided to enhance thedeformation of the clamp. As the set screw 3926 is threaded upward, tothe locked position shown in FIG. 98F, legs 3942, 3944 are biased towardeach other, resulting in legs 3942, 3944 gripping rod 50, 70therebetween. Thus, the top-loading portion 3910 of the connector 3900is able to reversibly attach to a spinal rod 50, 70 from above by beingplaced over the rod 50, 70 in the unlocked position (FIG. 98G) andsubsequently threading the threaded set screw 3926 upward into thelocked position (FIG. 98F) in order to close the clamp 3940 around thespinal rod 50, 70.

The second clamping portion 3950 is a closed connector having a secondpassage 3951 that has a second longitudinal axis 3954 extendingtherethrough. Second passage 3951 comprises a generally circular axialpassage, or through-opening 3953. Second longitudinal axis 3954 may besubstantially parallel or may be axially offset relative to firstlongitudinal axis 3914. The second passage 3951 is sized and dimensionedto allow the second rod, 50, 70, to be inserted thereinto along secondlongitudinal axis 3954.

Second clamping portion 3950 incudes a second securing mechanism 3952that is adapted to releasably secure second rod 50, 70 in second passage3953. Second securing mechanism 3950 includes a threaded through-hole3955 and a second set screw 3956 that is rotatably inserted intothrough-hole 3955. Set screw 3956 includes a threaded exterior thatthreadingly engages threaded through-hole 3955. First end 3958 of setscrew 3956 also includes a receiver opening 3959, such as, for example,for an Allen wrench or a Torx® wrench, and an engagement end 3960 thatextends into second passage 3951 to bias the rod 50, 70 against the wallof through-opening 3953 to secure rod 50, 70 within the connector 3900.

Connector 3900 can be used, for example, in a revision procedure to adda new construct to an existing construct or may be used a first orsingle procedure. By way of example only, opening 3912 can be insertedover first rod 70 in an existing construct. First connecting portion3910 can be secured to first rod 70 by rotating securing mechanism 3922and advancing clamp 3940 to the locked position to secure first rod 70to first connecting portion 3910. Second rod 50 can be inserted throughclosed through-opening 3953 and secured by set screw 3956, therebysecuring new spinal construct to the existing spinal construct.

An alternative embodiment of a connector 4000 is shown in FIG. 99.Connector 4000 is similar to connector 3900 including first clampingportion 3910 with the set screw 3926 and clamp 3940. Connector 4000differs from second connecting portion 3950 in that the closed opening3953 is replaced with a lateral side opening 4051. This lateral opening4051 is similar to the embodiment described and shown in FIG. 75.

Instead of generally circular passage 3951, in connector 4000, thesecond connector portion 4050 has second passage 4051 with an openingdefined by a generally U-shaped wall 4053 that allows connector 4000 tobe inserted over second rod 50, 70 (not shown) by a lateral connection.A set screw 4959 is threaded into a corresponding threaded opening tosecure the rod 50, 70 in the passage 4051 and against the wall 4053.Also, connector 4000 can be reversed such that second connecting portion4050 can be secured to existing rod 50, 70 and first connecting portion3910 can be secured to a new construct, such as rod 50, 70.

Another alternative embodiment of a connector 4100 is shown in FIG.4100. Connector 4100 is similar to connector 3900 including firstclamping portion 3910 with the set screw 3926 and clamp 3940. Connector4100 differs from second connecting portion 3950 in that the closedopening 3953 is replaced with a second connection portion 4150 having a“tulip style” connection. This is similar to the tulip-style embodimentdescribed and shown in FIG. 76.

Second connecting portion 4150 has a second passage with a generallyU-shaped opening 4151 that opens at the top of second connecting portion4150 and has a closed bottom wall 4153 that is arcuate in shape. Opening4154 is defined by bottom wall 4153 and opposing generally planar sidewalls 4156, 4158 that each includes threaded portions, respectively.After a rod 50, 70 is positioned within the opening 4151, these threadsare used to receive a securing member, such as set screw 4056 (shown inFIG. 99). The set screw 4056 is threaded downwardly until the rod 50, 70is secured against the bottom wall 4153.

The connectors described herein offer versatility in connecting spinalrod implants together. In the case of an existing construct beingaccessed in a revision surgery, the new fixation constructs may beattached without the need to remove the original surgical hardware.Attaching directly to existing spinal rod constructs saves operatingtime, causes less disruption to the patient, and improves patienthealing times. The connectors maximize utility in cases of varyingpatient anatomy and different configurations for existing constructs.The different connection modes offer a wide range of options forimproved patient outcomes.

It will be further understood that various changes in the details,materials, and arrangements of the parts which have been described andillustrated in order to explain the nature of this invention may be madeby those skilled in the art without departing from the scope of theinvention as expressed in the following claims.

What is claimed is:
 1. A connector for attaching to an existing bonefusion construct comprising: a main body having a first clamping bodyand a second clamping body laterally offset from the first clampingbody; the first clamping body being a top loading clamping body andhaving: a top portion having a vertical through opening defining avertical axis; a bottom portion extending downwardly from the topportion and having a first passage in communication with the throughopening and defining a first longitudinal axis extending therethrough,the first passage sized to receive a first rod of an existing bonefusion construct; and a threaded fastener sized to be threadablyreceived in the through opening; a clamp rotationally coupled to thefastener and having a plurality of downwardly extending legs that definean opening for receiving the first rod to be clamped, the fastener beingindependently rotatable relative to the clamp; and the second clampingbody having a second passage sized to receive a second rod.
 2. Theconnector according to claim 1, wherein the clamp has an unlockedposition configured to receive the first rod and a locked positionconfigured to releasably secure the first rod in an opening between thelegs, wherein the clamp in the locked position is disposed higher in thebottom portion than the clamp in the unlocked position.
 3. The connectoraccording to claim 2, wherein, in the locked position, the bottomportion is sized such that the legs move inwardly toward one another asthe clamp is driven upward in the bottom portion of the first clampingbody.
 4. The connector according to claim 1, wherein the first passageis defined by generally opposing sidewalls having one or more angledsurfaces and the opposing sidewalls are angled such that a width of thefirst passage in the bottom portion decreases upward.
 5. The connectoraccording to claim 1, wherein an inner wall of the bottom portion isangled such that a width of the first passage decreases in an upwarddirection such that the legs of the clamp tighten around the first rodas the clamp moves upward.
 6. The connector according to claim 5,wherein the fastener is coupled to the clamp such that rotation of thefastener translates the fastener and the clamp upwardly, but the clampdoes not rotate.
 7. The connector according to claim 1, wherein anannular protrusion on an engagement end of the fastener is received in arecess in a top portion of the clamp.
 8. The connector according toclaim 1, wherein the second clamping body includes a closed through holedefining a second longitudinal axis and the closed through hole isadapted to receive the second rod only along the second longitudinalaxis.
 9. The connector according to claim 1, wherein the second clampingbody includes a laterally open passage defining a second longitudinalaxis and adapted to receive the second rod along the second longitudinalaxis and along a direction lateral to the vertical axis.
 10. Theconnector according to claim 1, wherein the second clamping body is abottom loading clamping body and includes a generally open U-shapedopening facing upwardly and defining a second longitudinal axis, theU-shaped opening adapted to receive the second rod along the secondlongitudinal axis and from a top of the U-shaped opening transverse tothe second longitudinal axis.
 11. A connector for attaching to anexisting bone fusion construct comprising: a unitary body having a firstclamping body and a second clamping body laterally offset from the firstclamping body; the first clamping body being a top loading clamping bodyand having: a top portion having a vertical through opening defining avertical axis; a bottom portion extending downwardly from the topportion and having a first passage in communication with the throughopening and defining a first longitudinal axis extending therethrough,the first longitudinal axis being transverse to the vertical axis, thefirst passage sized to receive a first rod of an existing bone fusionconstruct; and a securing mechanism including a set screw and a secondclamp having a plurality of downwardly extending legs, and an openingdefined by the legs, the clamp being rotatably and nonthreadedlyconnected to the set screw and the set screw being threadedly receivedin the through opening of the top portion such that rotation of the setscrew slidably and vertically translates the clamp in the bottomportion; and the second clamping body having a second passage sized anddimensioned to receive a second rod.
 12. The connector according toclaim 11, wherein the clamp has an unlocked position configured toreceive the first rod and a locked position configured to releasablysecure the first rod in the opening between the legs and wherein, in thelocked position, the legs move inwardly toward one another as the clampis slidably translated upward in the body.
 13. The connector accordingto claim 12, wherein the first passage is defined by a sidewall havingone or more angled surfaces.
 14. The connector according to claim 13,wherein the sidewall is angled such that a width of the first passage isgreatest at a bottom of the opening and decreases upward.
 15. Theconnector according to claim 11, wherein the set screw is adapted torotate independently from the clamp.
 16. The connector according toclaim 11, wherein an annular protrusion on an engagement end of the setscrew is received in a recess in a top portion of the clamp.
 17. Theconnector according to claim 11, wherein the set screw is coupled to theclamp such that rotation of the fastener translates the set screw andthe clamp upwardly, but the clamp does not rotate.
 18. The connectoraccording to claim 11, wherein the second clamping body includes aclosed through hole defining a second longitudinal axis and the closedthrough hole is adapted to receive the second rod only along the secondlongitudinal axis.
 19. The connector according to claim 11, wherein thesecond clamping body includes a laterally open passage defining a secondlongitudinal axis and adapted to receive the second rod along the secondlongitudinal axis and along a direction lateral to the vertical axis.20. The connector according to claim 11, wherein the second clampingbody is a bottom loading clamping body and includes a generally openU-shaped opening facing upwardly and defining a second longitudinalaxis, the U-shaped opening adapted to receive the second rod along thesecond longitudinal axis and from a top of the U-shaped openingtransverse to the second longitudinal axis.